Foodborne Illness Outbreak Investigation Summary Society of Professional Journalists Awards Banquet, Bali Hai Restaurant, July 29, 2015 On Friday, July 31, 2015, the Coun of San Diego Epidemiology Program was notified of an outbreak of gastrointestinal illness follong a buffet style di1mer served to 172 attendees of the San Diego Society of Prossional Joalists awards banquet, held at the Bali Hai Restaant in Shelter Island on Jy 29, 2015. An investigation was initiated to identi the cause and scope of illnesses among the banquet attendees and reconunend appropriate prevention and control measures. Epidenuological I nvegaon lness and food stories were collected for 84 (49%) out of 172 attendees; of these, 50 (59.5%) met the outbreak case definition, incang that they presented with voting and/or diahea (�3 loose stools in a 24-hour period) within 72 hours of exposure at the event. Eight indiduals reported illness, but did not meet the outbreak case definition (i.e., vomiting and/or �3 loose stools in a 24-hour peod), and were therefore excluded om the analysis. Of the 84 individuals who responded, 14 (16. 7%) reported a total of 17 household or other close contacts with similar illness. these 17, ten were among the banquet attendees; as for the remaining seven ill contacts, it was unclear whether they were at the event or were possibly secondary cases with person-to-person transmission. Of 50 individuals who met the outbreak case definion, 44 (88.0%) presented with vomiting, 48 (96.0%) had diarrhea; 44 (88.0%) and 39 (78.0%) complained of abdominal cramps and body aches, respectively (Table 1). Illness onset dates ranged om July 30 to August 1, 2015 igure 1). Three individuals sought medical care, including one patient who was hospitalized r �24 hours. Median incubation period was 32 hours (range: 5.5-72.5 hours). Duration of illness ranged om 2 to 96 hours with a median of 24 hours. For patients with available infonnation, ages ranged om 19 to 92 years, with a median age of 48 years; 30 ( 60.0%) were male. The self-serve buffet menu included 3 main entrees (Jerk-spiced and pineapple-mm glaze pork loin, Teriyaki-roasted chicken, d Blackened salmon with roasted com relish), 2 sides (vegetable ied ce and garlic mashed potatoes), 4 salads Iouse blend local greens with giuger pJum vinaigrette, Island-style potato salad, Thai Caesar salad and Asian chopped salad), dessert (caot cake), and various b verage items with or,, ilhout ice. A case-control analysis was peormed to identi possible food exposures associated with illness (Table 2). A statistically significant association was found between illness and exposure to ice (Odds Ratio = 4.06, 95% Confidence Inteal: 1.31-12.62; P value = 0.01); odds of exposure to ice was 4 times greater among cases than among controls. Statistically speaking, no other od or beverage items were significantly associated with illness. Achiologic I m1esgaon Of 8 ill indiduals who submitted stool samples r testing, 7 (87.5%) were positive for Norovirus genogroup I (GI) RNA by Polymerase Chain Reaction (PCR) testing performed at the San Diego Cmmty Public Health Laboratory (SDCP). Of these, 5 were genotype 1 by sequence analysis peonned at the Califoa Department of Public Health Viral and Rickettsial Disease Laboratory. Environment He Jm,egaon Environmental health investigation at the restaurant included a detailed assessment of food preparation methods, od sa and hygiene practices, and food employees' health status. Recommendations r Norovirus cleaning were made to prevent adtional cases. Of 56 food employees who worked on July 29, only 6 were identified as specifically working at the event: 1 bartender, 3 seers and 2 cooks; none reported gastrointestinal illness during the week prior to the event. Two ill food workers (a line cook and a bartender) who did not work at the event were inteiewed in detail regarding their job duties, work schedules, and illness onset dates/times and durations; none reported working while symptomac. T11e line cook was out sick om July 27 to July 30; he reed to work on July 31. The bartender became ill one day aſter the event on July 30. None submitted stool samples to SDCP for Norovis testing. 2 •• .._ .••• w ••. s ... 2.: .. ..... .. w.a..........._..... .z_ .&...... . _ . w .. na. . . c ....... 6 ...... Ê&a .•. :. . ....... asc.wei:z . .. w ............ :s.c0;.m .. e. Epidemiolo and Immunization Services Agen, Coun ofSan Diego Health and Human Seices Agen September 28, 2015
Transcript
Foodborne Illness Outbreak Investigation Summary Society of Professional Journalists Awards Banquet, Bali Hai Restaurant, July 29, 2015
On Friday, July 31, 2015, the County of San Diego Epidemiology Program was notified of an outbreak of gastrointestinal illness following a buffet style di1mer served to 172 attendees of the San Diego Society of Professional Journalists awards banquet, held at the Bali Hai Restaurant in Shelter Island on July 29, 2015. An investigation was initiated to identify the cause and scope of illnesses among the banquet attendees and reconunend appropriate prevention and control measures.
Epidenuological I nvesrigation
Illness and food histories were collected for 84 ( 49%) out of 172 attendees; of these, 50 (59.5%) met the outbreak case definition, indicating that they presented with vomiting and/or diarrhea (�3 loose stools in a 24-hour period) within ;::,72 hours of exposure at the event. Eight individuals reported illness, but did not meet the outbreak case definition (i.e., vomiting and/or �3 loose stools in a 24-hour period), and were therefore excluded from the analysis.
Of the 84 individuals who responded, 14 (16. 7%) reported a total of 17 household or other close contacts with similar illness. Of these 17, ten were among the banquet attendees; as for the remaining seven ill contacts, it was unclear whether they were at the event or were possibly secondary cases with person-to-person transmission.
Of 50 individuals who met the outbreak case definition, 44 (88.0%) presented with vomiting, 48 (96.0%) had diarrhea; 44 (88.0%) and 39 (78.0%) complained of abdominal cramps and body aches, respectively (Table 1). Illness onset dates ranged from July 30 to August 1, 2015 (Figure 1). Three individuals sought medical care, including one patient who was hospitalized for �24 hours. Median incubation period was 32 hours (range: 5.5-72.5 hours). Duration of illness ranged from 2 to 96 hours with a median of 24 hours. For patients with available infonnation, ages ranged from 19 to 92 years, with a median age of 48 years; 30 ( 60.0%) were female.
The self-serve buffet menu included 3 main entrees (Jerk-spiced and pineapple-mm glaze pork loin, Teriyaki-roasted chicken, and Blackened salmon with roasted com relish), 2 sides (vegetable :fried rice and garlic mashed potatoes), 4 salads Iouse blend local greens with giuger pJum vinaigrette, Island-style potato salad, Thai Caesar salad and Asian chopped salad), dessert (carrot cake), and various b verage items with or,, ilhout ice.
A case-control analysis was performed to identify possible food exposures associated with illness (Table 2). A statistically significant association was found between illness and exposure to ice (Odds Ratio = 4.06, 95% Confidence Interval: 1.31-12.62; P value = 0.01); odds of exposure to ice was 4 times greater among cases than among controls. Statistically speaking, no other food or beverage items were significantly associated with illness.
A1icrohiological I m1estigation
Of 8 ill individuals who submitted stool samples for testing, 7 (87.5%) were positive for Norovirus genogroup I (GI) RNA by Polymerase Chain Reaction (PCR) testing performed at the San Diego Cmmty Public Health Laboratory (SDCPHL). Of these, 5 were genotype 1 by sequence analysis perfonned at the California Department of Public Health Viral and Rickettsial Disease Laboratory.
Environmental Heath Jm,esrigation
Environmental health investigation at the restaurant included a detailed assessment of food preparation methods, food safety and hygiene practices, and food employees' health status. Recommendations for Norovirus cleaning were made to prevent additional cases.
Of 56 food employees who worked on July 29, only 6 were identified as specifically working at the event: 1 bartender, 3 servers and 2 cooks; none reported gastrointestinal illness during the week prior to the event. Two ill food workers (a line cook and a bartender) who did not work at the event were interviewed in detail regarding their job duties, work schedules, and illness onset dates/times and durations; none reported working while symptomatic. T11e line cook was out sick from July 27 to July 30; he returned to work on July 31. The bartender became ill one day after the event on July 30. None submitted stool samples to SDCPHL for Norovirus testing. 2 •• ess.ss._ .••• w ••. s ... 2.: .. .: ..... x: .... w.a ........... _ ..... ss.z_ .&....... _ ... w .. na.. . ..... c ....... 22 ...... CA&a .•. :. . ....... as..c..wei:z. . .s .. w .............. :.:s.c..:0;.mws .. e...eas
Epidemiology and Immunization Services Agency, County of San Diego Health and Human Services Agency September 28, 2015
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State of California-Health and Human Services Agency
California Department of Public Health Center for Infectious Diseases Division of Communicable Disease Control Infectious Diseases Branch Surveillance and Statistics Section MS 7306, P.O. Box 997377 Sacramento, CA 95899-7377
Local ID Number (Please use the same ID number on preliminary and final reports to allow linkage to the same outbreak.)
Report Status 0Preliminary IB)Final 15-219
STATE State ID CDC ID USE
ONLY SSS Rec I Entry Date File Date
FOODBORNE DISEASE OUTBREAK REPORT
INSTRUCTIONS
Please use this form to report:
- Two or more cases of similar illness from separate households resulting from the ingestion of a common food, OR- Two or more cases of illness resulting from ingestion of food confirmed or suspected to be contaminated with botulism, marine toxins, or other chemicals.
Detailed instructions for completing this form can be found on the California Department of Public Health website at: http://www.cdph.ca.gov/pubsformsl forms/Documents/CDPH8567-lnstructions.pdf.
1. FOODHANDLER
Was a foodhandler implicated as the source of contamination? (required) ff Yes, specify (check only one) 0Yes [8]No 0Laboratory evidence DLaboratory and epidemiologic evidence
0Epidemiologic evidence DPrior experience makes this the likely source
Please note: The purpose of this report is to capture information about the actual outbreak itself. If a FOODHANDLER was implicated as the source of contamination, do NOT include the foodhandler's information in any section of this report that asks about case information; that is, do NOT include the food-handler in the case count, demographic data, any date fields, etc. Additional information about an implicated foodhandler may be included in the "Remarks" section at the end of this report. If any food handlers are involved in the outbreak as cases (not the source), they SHOULD be included in case information.
2. INVESTIGATION METHODS
Investigation Methods (check al/ that apply) Dlnterviews only of ill persons Dlnvestigation at original source (e.g., farm, marine estuary, etc.) [8]Case-control study (please attach report and I or tables) DFood product traceback 0Cohort study (please attach report and I or tables) 0Environmental or food sample testing IB)Food preparation review DOther (describe): Dlnvestigation at factory or production plant
Comments
3. DATES (PRIMARY CASES ONLY)
Date First Case Became 1/1 Date Last Case Became Ill Date of Initial Exposure (mmlddlyyyy) Date of Last Exposure (mmldd/yyyy) (required, mmldd/yyyy) (mmldd/yyyy)
07/30/2015 08/01/2015 07/29/2015 07/29/2015
Date LHD or State First Notified of This Outbreak (mmlddlyyyy) Time LHD or State First Notified of This Outbreak (hh:mm) Specify AM I PM 07/31/2015 12:23 DAM IB)PM
Date Investigation Initiated (mmlddlyyyy) Time lnvestiqation Initiated (hh:mm) Specify AM /PM 07/31/2015 12:39 DAM [8]PM
4. GEOGRAPHIC LOCATION
Reporting State If Multiple States Involved IB)California OOther: OExposure occurred in multiple states
D Exposure occurred in a single state, but cases resided in multiple states
ff Multiple States Involved, List Additional States
Reporting Local Health Jurisdiction ff Multiple Local Health Jurisdictions Involved
San Diego DExposure occurred in multiple jurisdictions DExposure occurred in a single jurisdiction, but cases resided in multiple jurisdictions
If Multiple Local Health Jurisdictions Involved, List Additional Local Health Jurisdictions
Name of Facility Where Exposure Occurred (If publicly available) City I Town of Exposure Bali Hai Restaurant Shelter Island
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5. PRIMARY CASES (DO NOT INCLUDE IMPLICATED FOODHANDLERS IN CASE COUNTS)
Case Definition (e.g., person, place, time) Vomiting and/or diarrhea (�3 loose stools in a 24-hour period) within approximately 72 hours of exposure at the San Diego Society of Professional Journalists awards banquet held at the Bali Hai Restaurant in Shelter Island on Wednesday, July 29, 2015
Characteristic Specify as Noted Characteristic Specify as Noted
# Lab-confirmed Cases 7
%Male 40
Number of # Probable Cases 43
Sex % Female 60 Primary Cases (round %s to total 1 DD)
# Estimated Total Primary Ill (required) 50
% Unknown
Characteristic # Cases Total # Cases for Whom % < 1 Year Information is Available
Death (required) 0 50 % 1 - 4 Years
Hospitalized 1 50
% 5- 9 YearsOvernight (required)
Visited Emergency 1 50
Age Group % 10 - 19 Years 2 Room (required) (round %s to total 1 DD)
Visited Health Care % 20 - 49 Years
46 Provider (including Urgent Care visits 1 50
% 50 - 74 Years 44
but excluding ER % ::>: 75 Years visits, required) 2
% Unknown 6
6. INCUBATION PERIOD (PRIMARY CASES ONLY)
Is incubation period known? Total# Cases for Whom Information is Available Incubation Period Specify Units [El Yes 0No
Shortest 5.5 0Min [El Hours 0Days
49 Median 32.0 0Min [El Hours 0Days
Longest 72.5 OM in [8)Hours DDays
7. DURATION OF ILLNESS (AMONG RECOVERED PRIMARY CASES ONLY)
Is duration of illness known? Total# Cases for Whom Information is Available Duration of Illness Specify Units [8)Yes 0No
Shortest 2.0 0Min [El Hours 0Days
35 Median 24.0 0Min [8)Hours 0Days
Longest 96.0 0Min [El Hours 0Days
8. SIGNS OR SYMPTOMS (PRIMARY CASES ONLY)
Sign I Symptom # Cases with Total # Cases for Whom
Sign I Symptom# Cases with Total# Cases for Whom
Sign I Symptom Information is Available Sign I Symptom Information is Available
Is etiology known Skip to Etiology - Details sections 14.1 and 14.2. Specify details of all confirmed and suspected etiologies. Name the or suspected? If Yes. bacterium, chemical I toxin, virus, or parasite. If available, include the species, serotype, and other characteristics such as
IB)Yes phage type, virulence factors, and metabolic profile.
0No Were patient specimens collected? How many patients had specimens What were they tested for? (check all that apply)
If No: IB)Yes 0No 0Unk collected and tested? !Bl Bacteria 0Chemicals I toxins 7 IB)Viruses 0Parasites
14.1 ETIOLOGY #1 - DETAILS (PRIMARY CASES ONLY)
Etiology 1 If E.coli/ STEC, specify serotype
D Bacillus cereus toxin 00157:H7 00103 00111:NM 00121 0026:H11 0045:H2 OOund OOther:. D Campy/obacter* 00157:NM 00103:H2 00118 0026 0045 0069:H11 0Unk D Clostridium botulin um toxin D Clostridium perfringens toxin If Salmonella, specify serotype
Other Characteristics (List distinguishing characteristics not already indicated on this form, e.g., species, genotype, etc.) D Staphylococcus aureus toxin D Suspected bacterial toxin, Norovirus genogroup I, genotype 1
type undetermined O Vibrio*
Confirmed outbreak etiology**? What was it detected in? (check all that apply) # Lab-confirmed OOther: 0Unk IB)Yes 0No !Bl Patient specimen D Environmental specimen Primary Cases
*Please indicate species in 0Food specimen 0Clinical evidence only 7
"Other Characteristics". 0Foodhandler specimen
**For most etiologic agents, CDC considers an outbreak to have a confirmed etiology if there are two or more lab-confirmed cases. However, because botulism, marine toxin, and other chemical outbreaks have such distinct clinical symptoms, a physician's diagnosis is often sufficient and laboratory confirmation is not necessary to classify an outbreak as having a confirmed etiology. Therefore, for such outbreaks, CDC would consider the etiology confirmed if there are at least 2 cases (lab confirmed and I or probable) with signs and symptoms meeting the confirmation criteria. Please refer to CDC's Guide to Confirming a Diagnosis in Foodborne Disease at: http://www.cdc.gov/outbreaknet/references_resources/guide_confirming_diagnosis.html.
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California Department of Public Health FOODBORNE DISEASE OUTBREAK REPORT
Local ID Number: 15-219 ������������
14.2 ETIOLOGY #2 - DETAILS (PRIMARY CASES ONLY)
Etiology 2 If E.coli/ STEC, specify serotype O Bacillus cereus toxin 00157:H? 00103 00111:NM 00121 0026:H11 0045:H2 OOund OOther: O Campylobacter* 00157:NM 00103:H2 00118 0026 0045 0069:H11 0Unk O Clostridium botulinum toxin O Clostridium perfringens toxin If Salmonella, specify serotype OE. coli/STEC 0Agona 0Heidelberg 0Kottbus 0Newport 0Typhi 0Unk 0Norovirus 0Braenderup 014,[5],12:i:- 0Mbandaka OOranienburg 0Typhimurium 0Salmonella OEnteritidis Olnfantis 0Montevideo 0Saintpaul 0Typhimurium var Copenhagen 0Scombroid toxin 0Hadar 0Javiana 0Muenchen 0Thompson OOther: 0Shigel/a* Other Characteristics (List distinguishing characteristics not already indicated on this form, e.g., species, genotype, etc.) D Staphylococcus aureus toxin O Suspected bacterial toxin,
type undetermined 0Vibrio* Confirmed outbreak etiology**? What was it detected in? (check all that apply) # Lab-confirmed OOther: 0Unk DYes 0No 0Patient specimen 0Environmental specimen Primary Cases *Please indicate species in 0Food specimen 0Clinical evidence only "Other Characteristics". 0Foodhandler specimen
**For most etiologic agents, CDC considers an outbreak to have a confirmed etiology if there are two or more lab-confirmed cases. However, because botulism, marine toxin, and other chemical outbreaks have such distinct clinical symptoms, a physician's diagnosis is often sufficient and laboratory confirmation is not necessary to classify an outbreak as having a confirmed etiology. Therefore, for such outbreaks, CDC would consider the etiology confirmed if there are at least 2 cases (lab confirmed and I or probable) with signs and symptoms meeting the confirmation criteria. Please refer to CDC's Guide to Confirming a Diagnosis in Foodborne Disease at: http://www.cdc.gov/outbreaknet/references_resources/guide_confirming_diagnosis.html.
15. ISOLATES
For bacterial pathogens, provide representative laboratory data for each distinct PFGE pattern, if available. For viral pathogens (norovirus and sapovirus), provide CaliciNet outbreak code, key, and genotype for each distinct strain identified in the outbreak, if available. If you do not have any isolates, enter "N/A" or "Unavailable" under "State or Local Lab ID" for Isolate 1 .
State o r Local Lab ID CDC PulseNet or CaliciNet Outbreak Code 16-004945, 16-005269
Isolate 1 CDC PulseNet Pattern Designation for Enzyme 1 CDC PulseNet Pattern Designation for Enzyme 2
CaliciNet Key I Other Molecular Designation 1 Ca/iciNet Genotype I Other Molecular Designation 2 Norovirus genogroup I
State or Local Lab ID CDC PulseNet or CaliciNet Outbreak Code 16-004901, 16-004991, 16-005085, 16-004899
Isolate 2 CDC PulseNet Pattern Designation for Enzyme 1 CDC PulseNet Pattern Designation for Enzyme 2
CaliciNet Key I Other Molecular Designation 1 CaliciNet Genotype I Other Molecular Designation 2 Norovirus genogroup I, genotype 1
State or Local Lab ID CDC PulseNet or CaliciNet Outbreak Code V15T04526-01
Isolate 3 CDC PulseNet Pattern Designation for Enzyme 1 CDC Pulse Net Pattern Designation for Enzyme 2 Norovirus genogroup I, genotype 1
CaliciNet Key/Other Molecular Designation 1 CaliciNet Genotype I Other Molecular Designation 2
16. IMPLICATED FOODS
Was a food vehicle identified or suspected? I If No or Unk, skip to Section 18.�Yes 0 No 0Unk
17.1 IMPLICATED FOOD #1 - DETAILS
Name of Food (e.g., beef lasagna) J lngredient(s) (e.g., ground beef, tomatoes, pasta, cheese, salt)Ice
Contaminated lngredient(s) (e.g., ground beef) I Total# Primary Cases Exposed to Implicated Food �Unknown 26
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California Department of Public Health FOODBORNE DISEASE OUTBREAK RE PORT
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17.1 IMPLICATED FOOD #1 - DETAILS (continued)
Reason(s) Suspected (check all that apply)
[811 - Statistical evidence from epidemiological investigation 0 4 - Other data (e.g., same phage type found on farm that supplied eggs) 0 2 - Laboratory evidence (e.g., identification of agent in food) 0 5 - Specific evidence lacking but previous experience makes it likely source 0 3 - Compelling supportive information
Method of Processing (prior to point-of service: processor; check all that apply)
Method of Preparation (at point-of-service; retail: restaurant, grocery store; select only one)
0 1 - Prepared in the home 0 2 - Ready to eat food: no manual preparation, no cook step (e.g., sliced cheese, pre-packaged deli meats; whole raw fruits; pre-shucked raw oysters, etc.) 0 3 - Ready to eat food: manual preparation, no cook step (e.g., cut fresh fruits and vegetables, chicken salad made from canned chicken, etc.) 0 4 - Cook and serve foods: immediate service (e.g., soft-cooked eggs, hamburgers, etc.) 0 5 - Cook and hot hold prior to service (e.g., soups, hot vegetables, mashed potatoes, etc.) 0 6 -Advance preparation: cook, cool, serve (e.g., sliced roast beef from a whole cooked roast, etc.) 0 7 -Advance preparation: cook, cool, reheat, serve (e.g., casseroles, soups, sauces, chili, etc.) 0 8 -Advance preparation: cook, cool, reheat, hot hold, serve (e.g., chili, refried beans, etc.) 0 9 -Advance preparation: cook-chill and reduced oxygen packaging (ROP) (e.g., sauces, gravies, cheeses, etc. packaged under ROP) 010 - Other or unknown
Level of Preparation (check all that apply)
0 1 - Foods eaten raw with minimal or no processing (e.g., washing, cooling) 0 2 - Foods eaten raw with some processing (e.g., no cooking, fresh cut and I or packaged raw) .
0 3 - Foods eaten heat processed (e.g., cooked: a microbiological kill step was involved in processing)
Contaminated food imported to U.S.? (This includes food hand-carried into the U.S.)
0Yes, country known (specify): 0Yes, country unknown 0No 0Unk
17.2 IMPLICATED FOOD #2 - DETAILS
Name of Food (e.g., beef lasagna) I lngredient(s) (e.g., ground beef, tomatoes, pasta, cheese, salt)
Contaminated lngredient(s) (e.g., ground beef) I Total# Primary Cases Exposed to Implicated Food 0Unknown
Reason(s) Suspected (check all that apply)
0 1 - Statistical evidence from epidemiological investigation O 4 - Other data (e.g., same phage type found on farm that supplied eggs) 0 2 - Laboratory evidence (e.g., identification of agent in food) 0 5 - Specific evidence lacking but previous experience makes it likely source 0 3 - Compelling supportive information
Method of Processing (prior to point-of service: processor; check all that apply)
D 1 - Pasteurized (e.g., liquid milk, cheese, juice, etc.) 0 7 - Frozen 0 2 - Unpasteurized (e.g., liquid milk, cheese, juice, etc.) 0 8- Canned 0 3 - Shredded or diced 0 9 -Acid treatment (e.g., commercial potato salad with vinegar, etc.) 0 4 - Pre-packaged (e.g., bagged lettuce or other produce) 01 O - Pressure treated (e.g., oysters, etc.) 0 5 - Irradiation 011 - Other or unknown 0 6 - Pre-washed
Method of Preparation (at point-of-service; retail: restaurant, grocery store; select only one)
0 1 - Prepared in the home 0 2 - Ready to eat food: no manual preparation, no cook step (e.g., sliced cheese, pre-packaged deli meats; whole raw fruits; pre-shucked raw oysters, etc.) 0 3 - Ready to eat food: manual preparation, no cook step (e.g., cut fresh fruits and vegetables, chicken salad made from canned chicken, etc.) 0 4 - Cook and serve foods: immediate service (e.g., soft-cooked eggs, hamburgers, etc.) 0 5 - Cook and hot hold prior to service (e.g., soups, hot vegetables, mashed potatoes, etc.) 0 6 -Advance preparation: cook, cool, serve (e.g., sliced roast beef from a whole cooked roast, etc.) D 7 -Advance preparation: cook, cool, reheat, serve (e.g., casseroles, soups, sauces, chili, etc.) 0 8 -Advance preparation: cook, cool, reheat, hot hold, serve (e.g., chili, refried beans, etc.) 0 9 -Advance preparation: cook-chill and reduced oxygen packaging (ROP) (e.g., sauces, gravies, cheeses, etc. packaged under ROP) 010 - Other or unknown
Level of Preparation (check all that apply)
D 1 - Foods eaten raw with minimal or no processing (e.g., washing, cooling) D 2 - Foods eaten raw with some processing (e.g., no cooking, fresh cut and I or packaged raw) 0 3 - Foods eaten heat processed (e.g._, cooked: a microbiological kill step was involved in processing)
Contaminated food imported to U.S.? (This includes food hand-carried into the U.S.)
0Yes, country known (specify): 0Yes, country unknown 0No 0Unk
CDPH 8567 (revised 2/13) Page 5 of 8
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18. LOCATION WHERE FOOD WAS PREPARED
Location Where Food was Prepared (check all that apply) O Restaurant - "Fast-food" (drive-up service or pay at counter) ONursing home (e.g., skilled nursing facility, long-term care facility) (&) Restaurant - Sit-down dining 0Assisted living facility, home care 0Restaurant - Other or unknown type 0Hospital 0Private home 0Child day care center (&)Banquet facility (food prepared and served on-site) 0School 0Caterer (food prepared off-site from where served) 0Prison, jail OF air, festival, other temporary or mobile services 0Church, temple, religious location 0Grocery store ocamp 0Workplace, not cafeteria OPicnic 0Workplace cafeteria OOther (describe in Remarks)
0Unknown
Remarks
19. LOCATION OF EXPOSURE (WHERE FOOD WAS EATEN)
Location of Exposure (check all that apply) D Restaurant - "Fast-food" (drive-up service or pay at counter) 0Nursing home (e.g., skilled nursing facility, long-term care facility) (&) Restaurant - Sit-down dining 0Assisted living facility, home care 0Restaurant - Other or unknown type 0Hospital O Private home 0Child day care center (&)Banquet facility (food prepared and served on-site) 0Schbol 0Caterer (food prepared off-site from where served) 0Prison, jail 0Fair, festival, other temporary or mobile services 0Church, temple, religious location 0Grocery store 0Camp 0Workplace, not cafeteria 0Picnic 0Workplace cafeteria OOther (describe in Remarks)
0Unknown
Remarks
20. CONTRIBUTING FACTORS
Are contributing factors known? I ff known, check all that apply in Section 21. ff unknown, skip to Section 22. 0Yes (&) No
21. CONTRIBUTING FACTORS - DETAILS
Contamination Factors (check all that apply) 0C1 - Toxic substance part of tissue 0C2 - Poisonous substance intentionally I deliberately added 0C3 - Poisonous substance accidentally I inadvertently added 0C4 - Addition of excessive quantities of ingredients that are toxic in large amounts 0C5 - Toxic container 0C6 - Contaminated raw product - food was intended to be consumed after a kill step 0C7 - Contaminated raw product - food was intended to be consumed raw or undercooked I underprocessed DCB - Foods originating from sources shown to be contaminated or polluted (such as a growing field or harvest area) 0C9 - Cross-contamination of ingredients (cross-contamination does not include ill food workers) 0C1 O - Bare-hand contact by a food handler /worker I preparer who is suspected to be infectious 0C11 - Glove-hand contact by a food handler /worker I preparer who is suspected to be infectious 0C12 - Other mode of contamination (excluding cross-contamination) by a food handler /worker I preparer who is suspected to be infectious 0C13 - Foods contaminated by non-food handler /worker I preparer who is suspected to be infectious 0C14 - Storage in contaminated environment 0C15 - Other source of contamination (specify): OC-N/A - Contamination factors not applicable
CDPH 8567 (revised 2/13)
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California Department of Public Health FOODBORNE DISEASE OUTBREAK REPORT
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/
21. CONTRIBUTING FACTORS - DETAILS (continued)
Proliferation I Amplification Factors (bacterial outbreaks only; check all that apply) 0P1 - Food preparation practices that support proliferation of pathogens (during food preparation) 0P2- No attempt was made to control the temperature of implicated food or the length of time food was out of temperature control (during food service
or display of food) 0P3 - Improper adherence of approved plan to use Time as a Public Health Control 0P4 - Improper cold holding due to malfunctioning refrigeration equipment 0P5 - Improper cold holding due to improper procedure or protocol 0P6 - Improper hot holding due to malfunctioning equipment 0P7- Improper hot holding due to improper procedure or protocol DPS- Improper I slow cooling D P9 - Prolonged cold storage D P10 - Inadequate modified atmosphere packaging 0P11 - Inadequate processing (acidification, water activity, fermentation) D P12 - Other situations that promoted or allowed microbial growth or toxic production (specify):. D P-N/A - Proliferation I amplification factors not applicable
Survival Factors (check all that apply) D S1 - Insufficient time and I or temperature control during initial cooking I heat processing 0S2 - Insufficient time and I or temperature during reheating D S3 - Insufficient time and I or temperature control during freezing 0S4 - Insufficient or improper use of chemical processes designed for pathogen destruction 0S5 - Other process failures that permit pathogen survival (specify): D S-N/A - Survival factors not applicable
22. POINT OF CONTAMINATION (CONFIRMED OR SUSPECTED)
Confirmed or Suspected Point of Contamination If before preparation, specify Reason(s) Suspected (check all that apply) D Before preparation D Pre-harvest DEnvironmental evidence D Preparation D Processing 0Epidemiologic evidence �Unknown IB]Unknown D Laboratory evidence
0Prior experience makes this a likely source
23. SCHOOL
Complete this section only if "School" is checked in either the "LOCATION WHERE FOOD WAS PREPARED" section or the "LOCATION OF EXPOSURE (WHERE FOOD EATEN)" section.
Did the outbreak involve a single or multiple schools? I Total Approximate Enrollment (for all involved students in all involved schools) 0Single 0Multiple (specify number of schools): schools number of students 0Unknown
Grade Levels for All Involved Students in All Involved Schools If Grade school, check all grades affected 0Preschool 0Grade school DK 01sl 02"d 03'd 04'h 05'h 06'h 0College I university I technical school 0Unknown or undetermined 07'h DS'h 09'h 010'h 011'h 012'h
Was the implicated food item provided to the school through the National School If Yes, was the implicated food item donated I purchased by: Lunch I Breakfast Program? OUSDA through the Commodity Distribution Program 0Yes 0No 0Unknown or undetermined 0The state I school authority
0Unknown or undetermined OOther (specify):
24. REMARKS AND CONCLUSIONS
Please provide a brief summary of the investigation findings and the conclusions drawn, include important aspects not covered elsewhere in the report. Indicate if any persons in sensitive occupations or situations (e.g., foodhandlers, children attending daycare) were involved or if any adverse outcomes occurred in special populations (e.g., pregnant women, immunocompromised persons). Attach any documents that provide additional information.
Remarks and Conclusions On Friday, July 31, 2015, the County of San Diego Epidemiology Program was notified of an outbreak of gastrointestinal illness following a buffet style food served to 172 attendees of the San Diego Society of Professional Journalists awards banquet held at the Bali Hai Restaurant in Shelter Island on Wednesday, July 29, 2015. An investigation was initiated to identify the cause and scope of illnesses among the banquet attendees and recommend appropriate prevention and control measures. Illness and food histories were collected for 84 (49%) individuals; of these, 50 (59.5%) met the outbreak case definition. Eight individuals reported illness but did not meet the clinical criteria for acute food borne illness and were therefore excluded from the analysis. A case-control analysis was performed to identify possible food exposures associated with illness (see attached Table). A statistically significant association was found between illness and exposure to ice (OR= 4.06, 95% Cl: 1.31-12.62; p-value = 0.013); odds of exposure to ice was 4 times greater among cases than among controls. Statistically speaking, no other food or beverage items were significantly associated with illness.
CDPH 8567 (revised 2/13) Page 7 of 8
California Department of Public Health FOODBORNE DISEASE OUTBREAK REPORT
Local ID Number: 15-219������������
25. REPORTING AGENCY AND OTHER KEY INVESTIGATORS
Local Health Jurisdiction I Lead Investigator Name I Investigator Title
San Diego Azi Maroufi Epidemiologist II
Telephone Number I Fax Number I E-mail I Date (mmldd/yyyy)
Dr. Eric McDonald, Medical Director Dr. Annie Kao, Senior Epidemiologist
26. PHEP - SEVEN MINIMAL ELEMENTS CHECKLIST
Below are the seven minimal elements for outbreak investigations as outlined in the CDC Public Health Emergency Preparedness (PHEP) Cooperative Agreement- Performance Measures Specifications and Implementation Guidance (pp. 56-60).
IB)AII seven minimal elements included in outbreak report [El 1 - Context/ background (e.g., population affected, location, geographical area(s) involved, etiology, etc.)
[El2 - Initiation of investigation (e.g., dates and times notification was received by the LHJ and initiation of investigation, etc.) IB)3 - Investigation methods (e.g., data collection and analyses methods, epi curve, case definition, exposure assessment and classification, etc.)
IB)4 - Investigation findings I results (e.g., epidemiologic, laboratory, and I or clinical results, other analytic findings, etc.)
IB)5 - Discussion and I or conclusions [El6 - Recommendations for controlling disease and I or preventing I mitigating exposure
